My first patient

She was an elderly women, most likely in her 60s (Many people have no idea what their age is. We must use some creative questions to get a good idea: How many harvests have you seen? Who was the chief when you were born? For children: how many moons have passed? How many teeth does she/he have?). Our lady had a leathery face that cracked whenever she smiled. She had very few teeth, but a beautiful smile. The elder, Coussa, took her blood pressure and recorded it on a crumbled, well-worn piece of paper she kept in a plastic bag. Evidently, they used patients logs to record their BP whenever they came in. Impressive I thought, they are more with-it here than some places in the states. She was here today because she had some headaches and she wanted a refill on her BP medicine. When I heard the words “BP” “medicine” “refill,” my heart sank a little. Huh? Here I am, in the middle of nowhere, and this lady needs her BP meds refilled? What about the weird tropical diseases? What about the different pathology I kept hearing about? I was dumbfounded. I quickly realized that everyone suffers from hypertension, even older women in Mali. Just do your job, and you will be fine. So, when I saw her medicines, I jumped a little. She was on Lasix and methyldopa, 2 drugs that are hardly ever used to treat hypertention in the US. I asked Maiga after she had left why those two drugs, and he said that was what they had available in the pharmacy in the clinic. I was floored. Every medical governing body in existence recognizes that hydrochlorothiazide is the first drug of choice to treat hypertension. It is cheap and very effective. Why was that not being done here? I had some work to do and some questions to ask, but after clinic.

The next stream of patients were pretty much representative of what I see everyday at the clinic: 6 month – 9 year old children with fever, headache, and weakness (signs of a malaria attack) compounded by some kind of upper respiratory infection or diarrhea. And what do we do to these patients you may ask? We pretty much get a thick blood smear on every child that comes in with fever or history of fever. Which makes sense as studies have shown here that 80% of the causes of fever in children are malaria. What does not make sense is giving them an anti-malarial drug before they even know if they have malaria or not. I suspect that about half to 3/4 of the patients we order a thick smear on have malaria and get the appropriate treatment. What about the rest though? They are told once they are seen by us to get the thick smear and get the medicine and that is it. No waiting around for the results to confirm if they have malaria. It really is rather sad and it frustrates the hell out of me. But what can I do? I can change the system. But that will take time, which I have a lot of.

There are some other problems I have with how the clinic is organized and run, which I will not get into here. Suffice it to say that the Craiger is on the case, and I hope to have a better clinic up and running soon.